Management and outcome of primary CNS lymphoma in the modern era

authors

• Houillier Caroline
• Soussain Carole
• Ghesquières Hervé
• Soubeyran Pierre
• Chinot Olivier
• Taillandier Luc
• Lamy Thierry
• Choquet Sylvain
• Ahle Guido
• Damaj Gandhi
• Agapé Philippe
• Moluçon-Chabrot Cécile
• Amiel Alexandra
• Delwail Vincent
• Fabbro Michel
• Jardin Fabrice
• Chauchet Adrien
• Moles-Moreau Marie-Pierre
• Morschhauser Franck
• Casasnovas Olivier
• Gressin Rémy
• Fornecker Luc-Matthieu
• Abraham Julie
• Marolleau Jean-Pierre
• Tempescul Adrian
• Campello Chantal
• Colin Philippe
• Tamburini Jérôme
• Laribi Kamel
• Serrier Caroline
• Haioun Corinne
• Chebrek Safia
• Schmitt Anna
• Blonski Marie
• Houot Roch
• Boyle Eileen
• Bay Jacques-Olivier
• Oberic Lucie
• Tabouret Emeline
• Waultier Agathe
• Martin-Duverneuil Nadine
• Touitou Valérie
• Cassoux Nathalie
• Kas Aurélie
• Mokhtari Karima
• Charlotte Frederic
• Alentorn Agusti
• Feuvret Loïc
• Garff-Tavernier Magali Le
• Costopoulos Myrto
• Mathon Bertrand
• Peyre Matthieu
• Delgadillo Daniel
• Douzane Hassen
• Genet Diane
• Aidaoui Bachir
• Hoang-Xuan Khê
• Gyan Emmanuel

document type

abstract

Objective - Real-life studies on patients with primary CNS lymphoma (PCNSL) are scarce. Our objective was to analyze, in a nationwide population-based study, the current medical practice in the management of PCNSL. Methods - The French oculo-cerebral lymphoma network (LOC) database prospectively records all newly diagnosed PCNSL cases from 32 French centers. Data of patients diagnosed between 2011 and 2016 were retrospectively analyzed. Results - We identified 1,002 immunocompetent patients (43% aged >70 years, median Karnofsky Performance Status [KPS] 60). First-line treatment was high-dose methotrexate-based chemotherapy in 92% of cases, with an increasing use of rituximab over time (66%). Patients <60 years of age received consolidation treatment in 77% of cases, consisting of whole-brain radiotherapy (WBRT) (54%) or high-dose chemotherapy with autologous stem cell transplantation (HCT-ASCT) (23%). Among patients >60 years of age, WBRT and HCT-ASCT consolidation were administered in only 9% and 2%, respectively. The complete response rate to initial chemotherapy was 50%. Median progression-free survival was 10.5 months. For relapse, second-line chemotherapy, HCT-ASCT, WBRT, and palliative care were offered to 55%, 17%, 10%, and 18% of patients, respectively. The median, 2-year, and 5-year overall survival was 25.3 months, 51%, and 38%, respectively (<60 years: not reached [NR], 70%, and 61%; >60 years: 15.4 months, 44%, and 28%). Age, KPS, sex, and response to induction CT were independent prognostic factors in multivariate analysis. Conclusions - Our study confirms the increasing proportion of elderly within the PCNSL population and shows comparable outcome in this population-based study with those reported by clinical trials, reflecting a notable application of recent PCNSL advances in treatment.

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